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Cholera threatens Kabul

Eight people have died so far, and more than 2,000 may be infected, a health expert says. An emergency task force has begun chlorinating wells in the city.

Associated Press
Published June 15, 2005

KABUL, Afghanistan - An outbreak of cholera in the Afghan capital has killed at least eight people, is feared to have infected more than 2,000 others and is on the verge of turning into an epidemic, a senior epidemiologist working to stem the spread of the disease warned Tuesday.

Health officials in the war-shattered city of 4-million, where rubbish and sewage fill roadside ditches and water wells are polluted, disputed the figures and said the threat had been contained. Nevertheless, dozens of tents were being pitched in hospital gardens to isolate patients should the number of cases spike.

"An epidemic is about to break out here," said Fred Hartman, an epidemiologist and technical director for a U.S. Agency for International Development-backed program, the Rural Expansion of Afghanistan's Community-based Health Care. "Cholera is an explosive disease. As soon as water sources are contaminated, it spreads."

The disease has been detected in wells, the source of drinking water for most Kabul residents, and irrigation ditches, while more than 2,000 sick people have been reported with symptoms that "meet the case definition of cholera," said Hartman, who has combated outbreaks of the disease around the world for 30 years and has been involved with efforts to contain it in Afghanistan.

He told the Associated Press that eight or nine people had died in the past two weeks, and warned the disease could spread quickly throughout Kabul and to other provinces.

There is no scientific threshold for defining when an outbreak becomes an epidemic; it is largely a judgment call. But when an outbreak affects large numbers of people, experts tend to classify it as an epidemic.

Despite the threat, Hartman said, the government was well-equipped to deal with the crisis and had set up an emergency task force, which has started chlorinating wells, distributing medicine to hospitals and educating the public about the dangers of the disease and how to avoid catching it.

"For an undeveloped, war-torn country, Afghanistan's ministry of health has been able to respond very well," he said.

At Kabul's Infectious Diseases Hospital, about a dozen white tents in a yard were being equipped with beds and metal stands for intravenous drips. Inside one tent for women, a nurse with a mask over her mouth and a visor over her eyes was tending three sick women. Inside the women's ward, 15 beds were being lined up in a corridor.

Tents have also been pitched outside two other hospitals in the city, said Abdullah Fahim, an adviser to the health minister.

He said that about 2,400 people have been diagnosed with acute diarrhea but that only 30 were confirmed to have cholera. He said two children and an adult who died with diarrhea were suspected of having cholera.

"There is no need to declare that there is an epidemic. It would just create panic and we don't want to scare people," Fahim said.

Cholera is a major killer in developing countries, where it is spread mainly through contaminated food or water. The bacterium attacks the intestine and causes severe diarrhea and dehydration.

Hartman, who works closely with the Health Ministry, declined to comment on the government's lower death toll. He said the discrepancy in the official number of cholera cases and the figures he gave was because of the way cholera outbreaks are treated.

The last cholera outbreak in Kabul was in 2003, but it was minor and quickly addressed. In 2001, 114 people died from an outbreak in the country's north, according to the World Health Organization's Web site. It had no information on the latest cases.